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Dutch EU Presidency Conference on Antimicrobial Resistance [EU.NL-AMR] [713955] - Presidential Conference
Project abstract

During their EU Presidency, the Netherlands will organize a Ministerial Conference on Antibiotic Resistance on the 9th (evening only) and 10th of February 2016 in Amsterdam. All EU/EEA Ministers for Health and Agriculture will be invited. Aims is to discuss progress to combate AMR in the EU so far and the need for (measurable) action in the near future, with a focus on a One Health approach.
The conference should lead to an outcome document, and be adopted in both Health and Agriculture Council.

Summary of context, overal objectives, strategic, relevance and contribution of the action

Antibiotics are one of the biggest life savers of modern times. But overuse and misuse pose a threat to human and animal health. The growing problem of antimicrobial resistance increases costs of care and has economic implications for society. Antimicrobial resistance (AMR) has been addressed in the EU for a number of years now, among others leading to an EU Action Plan. In addition, this year’s World Health Assembly has unanimously adopted the Global Action Plan on AMR in which all member states of WHO are urged to have a national action plan in place within the next two years.
We have formulated the following objectives:

1. One health leadership
a) Health Ministers should coordinate a One Health approach to AMR in cooperation with Ministers of Agriculture and Environment. This means: to urge upon Ministers to take measures from the public health perspective in all domains; healthcare, animals, food safety and the environment.
b) National action plans should be developed in cooperation with relevant stakeholders in public and private sectors and preferably signed by all responsible ministers. Member States (MS) should have a national action plan based on a One Health approach by mid 2017, as stated in the WHO
c) Global Action Plan adopted during the World Health Assembly in May 2016.

2. Solid national Action Plans
a) Based on the EU decision on cross border health threats; MS have to present to the Health Security Committee (HSC) their national action plan with measurable targets before mid 2017, and hold each other accountable via the HSC.
b) MS use assessment tools (country-to-country assessment, ECDC assessment, surveillance data presented to ECDC) to demonstrate to the HSC progress in implementation and contribution to the EU targets in the EU Action Plan.

3. Commit to EU Action
Action within the EU
a) MS ask the Commission to develop a new EU Action Plan, with firm goals[1]:
b) Antibiotic resistance of bacteria in humans and animals in the EU decreases in the next five years
c) The differences between MS, in use of antibiotics in both human and animal health, decrease in the next five years , whereas also member states with a relatively low use should try to further pursue prudent use of antibiotics.
d) Healthcare Associated Infections in the EU decrease in the next five years
e) Specify biosecurity (infection prevention) measures in animal husbandry by prioritizing the adoption of a delegating act under the Animal Health Law
f) Concrete actions to reach these goals are suggested to the Commission by the MS (we will provide an annex)
g) MS politically commit to the new EU Action Plan by adoption in the both the Health and Agriculture and Fisheries Councils

Action outside the EU
MS commit to putting AMR on the agenda of the UN general Assembly in September 2016
a) Commit to contribute to implementing WHO GAP AMR and FAO AMR resolutions, including phasing out of use of antibiotics for animal growth promotion and reduction in nontherapeutic use of antimicrobial medicines in animals[2]
b) Legislate prudent use of antibiotics in animals in the interest of public health
c) Ban on the use of last resort drugs in animals, In livestock, susceptibility testing has to be mandatory before using antibiotics which are of critical importance to human health
Both require implementation through the veterinary medical products legislation

5. A next step in the development of new antibiotics
Putting in place a strategic expert commission to define a yearly prioritized r&d agenda in 2016, based on an analysis of gaps in EU research on new antibiotics and alternatives for antibiotics presented during the conference on 10th February 2016

Methods and means

- We prepared the story line and content of the films for the scenario based policy discussion
- We prepared the content and progamme of the conference and checked this with relevant parties ao the European Commission
- Writing and revising the outcome document
- We had preparatory meetings with the European Commission either in Brussels or through a teleconference
- We had working visits to member state capitals
- We wrote and sent out the save the dates and invitations
- Organisation of a dinner in the Krasnapolski Hotel in Amsterdam
- Organisation of a cultural visit and welcome cocktail in the Micropia Museum
- Development of the AMR Next magazine
- Preparation sessions with moderator and the Minister

Work performed during the reporting period

There were Working Party-meetings of Attachés of Public Health and Agriculture.

The main output achieved so far and their potential impact and use by target group (including benefits)

Conclusions and findings as presented during the EU Ministerial One Health Conference on AMR on the 10th of February 2016, Amsterdam

• There is a broad support for an EU One Health approach.
• There is political will to take next steps. Existing possibilities for European cooperation regarding cross border health threats should be used.
• Results and what we do is important, not structures or how we do it. We need a practical approach, focussed on action and implementation.
• There is consensus that a new EU One Health Action Plan is needed. Setting targets in the EU and in National Action Plans are important. Views are exchanged on how we can hold each other accountable on progress towards these targets. Further discussions on accountability are needed.
• There is agreement that we need to establish twinning mechanisms and country to country peer review.
• The importance of a ban on the preventive use of antibiotics in animals and firm restrictions on antibiotics that are of critical importance to human health are discussed and should be discussed further.
• Some countries suggest that framing of AMR as a health security issue may provide more possibilities to act together on a political level.
• Economic benefits and costs of AMR should be addressed as an integrated part of AMR policy.
• There is a need for a new EU R&D policy, in which Ministers of Health and Agriculture are more involved into developing the EU research agenda. We have to better align national investments to promote research into new antibiotics, alternatives (e.g. vaccines) and diagnostics, as well as into prudent use of new and existing antibiotics. Delinking investment costs from sales (volume) of antibiotics are discussed as an important element in future business models to develop new antibiotic therapies.
• There is a common view that existing - but not regularly used - antibiotics can still be used more effectively , and they need to be kept on the market.
• There is a broad support for putting AMR on the Global Agenda, including the UNGA of 2016, to ensure commitment of Heads of State for a One health – multisectoral approach to AMR.
• The EU has to take a common position in the global fora. The EU needs to take a leading role and can make a huge contribution to the implementation of the WHO Global Action Plan on AMR worldwide.

Achieved outcomes compared to the expected outcomes

We achieved what we expected. We had two objectives:

1. Increase level of responsibility and accountability within Europe
In general we expect a high level engagement across Europe for selected topics, beyond the level
of awareness, commitment and good intentions.
We are aware that the fight against AMR is a national competence. However, its cross-border
character requires response in all MS and in all sectors. We want countries to acknowledge the
need to take action and to express willingness to be held accountable by others for progress at
national level. The Cross Border Health Threats directive provides possibilities to do this.

2. Join forces on global issues
Besides actions that are needed within the European Union, we aim for clear joint statements or
positions in several global discussions. All countries have already agreed, through the WHA
2015, to set up a national action plan before 2017. We want Europe to be a global frontrunner by
ensuring that all MS comply to this target. Moreover, we would like all MS to support the
proposal to discuss AMR at the UN General Assembly in 2016.
The outcome of the conference will form the basis of (short) Council conclusions that will be
discussed in a joint attaché group, and put on the agenda of both the Health Council and
Agricultural Council in June 2016.

Dissemination and evaluation activities carried out so far and their major results

The conclusions of the conference have been shared with the participants. The Council Conclusions that were adopted last June were also shared with participants. The council conclusions and Preparations of the Joint Action on AMR have been started and all the member states have shown willingness to participate in the JA. The main aim of JA is to follow up on the Council Conclusions. Furthermore, the scenario films are (upon request) available for participants and other experts and policy makers.

Start date: 01/11/2015
End date: 31/07/2016
Duration: 9 month(s)
Current status: Finalised
Programme title: 3rd Health Programme (2014-2020)
EC Contribution: € 100 000,00
Keywords: Amr, Precidency